ABSTRACT
Objective: To assess the diagnostic accuracy of the Alvarado score in acute appendicitis
Study design: A cross sectional study
Place and duration: The study was conducted at the Accident and Emergency Department of KVSS Site Hospital during a period of 12 months from 1 Jan 2012 to 31 Dec 2012
Methodology: Hundred and ten consecutive patients who attended emergency department of KVSS Site Hospital with provisional diagnosis of acute appendicitis were included in this study after informed consent. Alvarado score was recorded and according to the aggregate score, patients were divided into two groups with scores of <5 and >/=5. The clinical diagnoses and operative findings of patients who were subjected to surgery for Alvarado score>/= 5 were compared with their histopathology reports. A self designed questionnaire was used to record relevant data including patients' age, gender, weight, Alvarado score and histopathology
Result: Out of total 110 cases [79 males, 31females], 28.2% [n=31] belonged to Group-A and 71.81% [n=79] belonged to Group-B. Surgical procedures were performed in 98.2% of cases, along with conservative treatment. Final diagnosis by histopathology was confirmed in 71.3% [n=77] cases. The overall negative appendectomy rate was 28.7% [males: 28.2%, females: 30%]. Sensitivity and specificity of Alvarado scoring system was found to be 93.5% and 80.6% respectively. Positive and negative predictive values were 92.3% and 83.3% respectively and accuracy was 89.8%
Conclusion: The Alvarado score is highly effective and non-invasive in the diagnosis of acute appendicitis
ABSTRACT
To compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's open haemorrhoidectomy. Comparative study. Surgical Unit 1, Ward-3, Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, from March to September 2006. Sixty patients of late 2nd, 3rd and 4th degree haemorrhoids were selected for admission from the outpatient department after taking informed consent. Patients with concomitant anal disease [e.g. fissure, abscess, fistula, ano-rectal cancer etc.] were excluded. Two groups of thirty each were made, one for Milligan-Morgan open haemorrhoidectomy and another for stapled haemorrhoidectomy, in which excision of a ring of mucosa proximal to the haemorrhoid[s] was done thus, interrupting the blood supply but maintaining continuity of the rectal mucosa. The operative time was measured in minutes. Postoperative pain was assessed through VAS. Bleeding was measured as no, mild, profuse. Other post-operative complications during hospital stay like urinary retention, anal stenosis etc. were noted. Student t-test, chi-square test and repeated measured analysis of variance were applied to compare the variables. The mean age was 40.7 +/- 11.6 years. A majority [53.3%] of patients [combined% in both groups] had third degree haemorrhoid. The mean length of operative time was found statistically insignificant between open and stapled groups [19.6 +/- 5.9 vs. 22.4 +/- 7.2 minutes, p=0.974]. However, the mean length of postoperative hospital stay was significantly less in the stapled than open haemorrhoidectomy group [3.37 +/- 2.2 vs. 2.03 +/- 0.81 days, p=0.003. Mean postoperative pain [observed by VAS] in the stapled group was significantly less than the open haemorrhoidectomy group [4.43 +/- 1.25 vs. 7.37 +/- 0.72]. The proportion of postoperative bleeding, infection, anal tag, urinary retention, tenderness on digital rectal examination and wound discharge was higher in open than stapled haemorrhoidectomy group, but statistically insignificant [p < 0.05]. There was a significant difference between Milligan Morgan's and stapled haemorrhoidectomy for postoperative pain and hospital stay. However the mean length of operative time was insignificantly different